超声引导下射频消融治疗甲状腺乳头状癌颈部转移淋巴结的疗效评价

摘要

Objective To assess the effectiveness and safety of ultrasound-guided percutaneous radiofrequency ablation (RFA) for nonsurgical treatment of metastatic lymph nodes (LNs) in the neck from papillary thyroid carcinoma (PTC).Methods Totally 45 PTC patients who had been treated with total thyroidectomy and radioiodine therapy were enrolled in this retrospective study.A total of 71 metastatic LNs in the neck from PTC were confirmed by percutaneous biopsy.Follow-up consisted of conventional ultrasound,contrast-enhanced ultrasound,and thyroglobulin (Tg) measurement 1,3 and 6 months after RFA and then every 6 months.Results All 45 patients were successfully treated,without immediate or later major complications occurred.During the follow-up [(23 ± 5) months;range:12-30 months)],there was no evidence of recurrence at ablated sites.The mean volume reduction ratio (VRR) was significantly reduced during the follow-up.Significant differences in the VRR were found between every two follow-up visits (P ＜ 0.001).Furthermore,46 metastatic LNs (64.8％) completely disappeared and 25 metastatic lymph nodes (35.2％) remained as small scar-like lesions at the last follow-up visit.After RFA,mean serum Tg level decreased from (11.3 ±6.3) ng/ml (range:0.8-19.4 ng/ml) to (1.3 ±0.9) ng/ml (range:0.2-3.9 ng/ml) at the last follow-up visit (P ＜0.001).Conclusion Ultrasound-guided percutaneous RFA is a safe and effective therapy for patients with cervical LNs metastasis from PTC.%目的 评估超声引导下射频消融治疗甲状腺乳头状癌颈部转移淋巴结的可行性、有效性和安全性.方法 45例经手术与放射性131I治疗后的甲状腺乳头状癌患者,共71枚治疗前经穿刺活检证实为甲状腺乳头状癌颈部转移淋巴结纳入本次研究.射频消融治疗前及治疗后1、3、6个月及其后每6个月进行常规超声、超声造影、血清甲状腺球蛋白(Tg)检查随访并评价治疗效果.结果 71枚转移淋巴结均成功完全消融,成功率100％.所有45例患者均未发生明显的严重并发症.术后平均随访时间(23±5)个月(12～30个月),至末次随访消融区未见复发.所有消融转移淋巴结均于术后l、3、6个月及其后每6个月进行随访,转移淋巴结体积均比术前及前次检查显著缩小(P均＜0.001),其中46枚(64.8％)转移淋巴结最终消失,25枚(35.2％)转移淋巴结仅残留瘢痕.末次随访血清Tg水平从(11.3±6.3) ng/ml(0.8 ～ 19.4 ng/ml)降至(1.3±0.9) ng/ml(0.2～3.9ng/ml) (P＜0.001).结论 超声引导下射频消融可安全、有效地治疗甲状腺乳头状癌颈部淋巴结转移的患者.